Skip to main content
SpringerLink
Log in

CT-Guided Transfemoral Portocaval Shunt Creation

  • Case Reports
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

A patient with superior vena cava (SVC) occlusion presented with severe ascites and urgent transjugular intrahepatic portosystemic shunt (TIPS) was requested. The patient had a chronically occluded SVC. An alternative to classic TIPS was employed using CT guidance to traverse the left portal vein to the inferior vena cava with a small gauge needle. Fluoroscopic guidance was then used to snare a wire placed through the needle and then work from the femoral vein to create a portocaval shunt that passed through the caudate lobe. This procedure was a technical success and improved the patient’s ascites.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Rossle M, Haag K, Blum HE (1996) The transjugular intrahepatic portosystemic stent-shunt: A review of the literature and own experiences. J Gastroenterol Hepatol 11:293–298

    Article  CAS  PubMed  Google Scholar 

  2. Ochs A, Rossle M, Haag K, Hauenstein KH, Deibert P, Siegerstetter V, Huonker M, Langer M, Blum HE (1995) The transjugular intrahepatic portosystemic stent-shunt procedure for refractory ascites. N Engl J Med 332:1192–1197

    Article  CAS  PubMed  Google Scholar 

  3. La Berge JM, Ring EJ, Gordon RL (1991) Percutaneous intrahepatic portosystemic shunt created via a femoral vein approach. Radiology 181:679–681

    Google Scholar 

  4. Soares GM, Murphy TP(1999) Transcaval TIPS: Indications and anatomic considerations. J Vasc Interv Radiol 10:1233–1238

    Article  CAS  PubMed  Google Scholar 

  5. Haskal ZJ, Duszak R Jr, Furth EE (1996) Transjugular intrahepatic transcaval portosystemic shunt: The gun-sight approach. J Vasc Interv Radiol 7:139–142

    Article  CAS  PubMed  Google Scholar 

  6. Quinn SF, Sheley RC, Semonsen KG (1997) Creation of a portal vein to inferior vena cava shunt using CT guidance and a covered endovascular stent. AJR 169:1159–1160

    Article  CAS  PubMed  Google Scholar 

  7. Palmaz JC, Sibbitt RR, Reuter SR, Garcia F, Tio FO (1985) Expandable intrahepatic portacaval shunt stents: Early experience in the dog. AJR 145:821–825

    Article  CAS  PubMed  Google Scholar 

  8. Fontaine AB, Verschyl A, Hoffer E, Borsa J, Dowd M (1997) Use of CT-guided marking of the portal vein in creation of 150 transjugular intrahepatic portosystemic shunts. J Vasc Interv Radiol 8:1073–1077

    Article  CAS  PubMed  Google Scholar 

  9. LaBerge JM, Somberg KA, Lake JR, Gordon RL, Kerlan RK Jr, Ascher NL, Roberts JP, Simor MM, Doherty CA, Hahn J, et al. (1995) Two-year outcome following transjugular intrahepatic portosystemic shunt for variceal bleeding: Results in 90 patients. Gastroenterology 108:1143–1151

    Article  CAS  PubMed  Google Scholar 

  10. Haskal ZJ, Pentecost MJ, Soulen MC, Shlansky-Goldberg RD, Baum RA, Cope C (1994) Transjugular intrahepatic portosystemic shunt stenosis and revision: Early and midterm results. AJR 163:439–444

    Article  CAS  PubMed  Google Scholar 

  11. Hausegger KA, Sternthal HM, Klein GE, Karaic R, Stauber R, Zenker G (1994) Transjugular intrahepatic portosystemic shunt: Angiographic follow-up and secondary interventions. Radiology 191:177–181

    CAS  PubMed  Google Scholar 

  12. Saxon RR, Mendel-Hartvig J, Corless CL, Rabkin J, Uchida BT, Nishimine K, Keller FS (1996) Bile duct injury as a major cause of stenosis and occlusion in transjugular intrahepatic portosystemic shunts: Comparative histopathologic analysis in humans and swine. J Vasc Interv Radiol 7:487–497

    Article  CAS  PubMed  Google Scholar 

  13. Saxon RS, Ross PL, Mendel-Hartvig J, Barton RE, Benner K, Flora K, Petersen BD, Lakin PC, Keller FS (1998) Transjugular intrahepatic portosystemic shunt patency and the importance of stenosis location in the development of recurrent symptoms. Radiology 207:683–693

    CAS  PubMed  Google Scholar 

  14. Cohen GS, Young HY, Ball DS (1996) Stent-graft as treatment for TIPS-biliary fistula. J Vasc Interv Radiol 7:665–668

    Article  CAS  PubMed  Google Scholar 

  15. Saxon RR, Timmermans HA, Uchida BT, Petersen BD, Benner KG, Rabkin J, Keller FS (1997) Stent-grafts for revision of TIPS stenoses and occlusions: A clinical pilot study. J Vasc Interv Radiol 8:539–548

    Article  CAS  PubMed  Google Scholar 

  16. Andrews RT, Saxon RR, Bloch RD, Petersen BD, Uchida BT, Rabkin JM, Loriaux MM, Keller FS, Rösch J (1999) Stent-grafts for de novo TIPS: Technique and early results. J Vasc Interv Radiol 10:1371–1378

    Article  CAS  PubMed  Google Scholar 

  17. Haskal ZJ (1999) Improved patency of transjugular intrahepatic portosystemic shunts in humans: Creation and revision with PTFE stent-grafts. Radiology 213:759–766

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, 98195, Seattle, WA, USA

    Robert Bloch M.D., Arthur Fontaine, John Borsa & Eric Hoffer

  2. Department of Medicine, Division of Gastroenterology and Hepatology, University of Washington School of Medicine, 1959 NE Pacific Street, 98195, Seattle, WA, USA

    Kris Kowdley

Authors
  1. Robert Bloch M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arthur Fontaine
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Borsa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eric Hoffer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kris Kowdley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert Bloch M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bloch, R., Fontaine, A., Borsa, J. et al. CT-Guided Transfemoral Portocaval Shunt Creation. Cardiovasc Intervent Radiol 24, 106–110 (2001). https://doi.org/10.1007/s002700002529

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s002700002529

Key words

Search

Navigation